From: "Doyle, Briatma"

From: "Doyle, Briatma" To: ' Subject: Questionnaire Date: Mon, 26 Oct 2015 13:37:23 +0000 Attachments: NEW PATIENT FORM.pdf Inline-Images: image001.png; image002.png; image003.png; image004.png; image005.png Good morning, I have attached a questionnaire to this email for the patient to please complete prior to his appointment and bring with him to his consultation with Or. Rawlins on October 27, 2015 at 9:15A along with any relevant radiology imaging and reports related to his spinal issue. I do need to know the following information prior to the appointment: Leg or arm pain? How long? Injections? How many? Pain medication the patient is taking and if he is pain management. We are located at Thank you, BRIANNA DOYLE Surgical Coordinator Dr. Bernard A. Rawlins TEL FAX ;hhttplAw uii Av.hss.edmagestic 4sonsiemail-icon-logo.ong htt htt htt Mt on the 2nd Floor in-between York Avenue and the East River. EFTA00336874